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Background Thrombus aspiration (TA) in patients with ST segment elevation myocardial infarction (STEMI) results in a better myocardial perfusion. Optical coherence tomography (OCT) after stenting in STEMI, however, often reveals residual atherothrombotic material. We assessed the feasibility of quantification of residual atherothrombotic burden and its relation to indices of myocardial perfusion. The effect of TA on residual in-stent atherothrombotic burden (ATB) is explored. Methods and results Forty patients with STEMI within 12h of symptom onset, underwent OCT after stent implantation. No complication related to the invasive imaging was detected and all cases had good image quality. All 40 cases revealed ATB (median, range; 2.85, 0.08–8.84) despite an optimal angiographic result. Patients were divided into two groups according to the ATB: ≥4=ATB high (n=15) and low (n=25). Patients with ATB low more often obtained a myocardial blush grade (MBG) of 2/3: 24 (96%) vs. 11 (73%), p=0.04 and a ≥50% ST segment resolution 24 (96%) vs. 8 (53%) p=0.02. Incomplete stent apposition is more often detected with ATB low : 1.97 (0.62–4.73) vs. 0.33 (0.04–0.92), p=0.002. TA was performed in 20 (50%) patients. ATB was numerically lower in patients with TA: 2.37 (1.70–5.10) vs. 3.40 (1.45–4.96), p=0.67. Logistic regression identified ATB as predictor of ST resolution failure (OR: 2.5 (95% confidence interval: 1.27–4.98), p value=0.008). Conclusions OCT can be safely performed in patients presenting for primary PCI and allows quantification of residual atherothrombotic material, the amount of which is associated with worse myocardial perfusion.

Background Although measurement of stent strut by optical coherence tomography (OCT) is important as an index for evaluating incomplete stent apposition, the effects of drug-eluting stents (DES) polymer on it are unknown. Methods and results DES and bare-metal stents (BMS) as platforms of DES were implanted in an artificial artery. Thickness of stent strut, defined as a distance from inner surface of the strut to the adjacent surface of the tube, and thickness of high-signal band were measured by OCT. Each measurement of DES was significantly larger comparing with BMS. Conclusion This in-vitro study demonstrates that DES polymer may influence OCT measurement for the stent strut.